Chronic gastritis

1.

Chronic Gastritis
By sourabh sharma
La1 174(2)

2.

Definition
The chronic inflammation
of gastric mucosa.

3.

4.

Chronic gastritis

5.

Etiology
Helicobacter pylori
infection

6.

7.

Helicobacter pylori

8.

Etiology
auto-immunologic fator
high positive rate (90%) of serum antiparietal cell antibody (APCA)
animal model: gastritis induced by
injecting APCA repeatedly
high positive rate (75%) of serum
anti-intrinsic factor antibody

9.

Other factors
reflux of duodenal juice
incompetence of pyloric sphincter
post operate stomach
alcohol
heavy salty foods
aging
portal hypertension
…...

10.

Classification of chronic gastritis
Chronic antral gastritis
(Type B gastritis)
H. Pylori infection (90%)
NSAIDs
alcohol
…...

11.

Classification of chronic gastritis
Chronic corpus
gastritis (Type A
gastritis)
auto-immunologic factors
Chronic pangastritis

12.

Histology
Chronic superficial gastritis
Chronic inflammation without
glandular atrophy

13.

Chronic
superficial
gastritis

14.

Chronic atrophic gastritis
Chronic inflammation with
glandular atrophy

15.

Chronic atrophic gastritis

16.

Chronic gastritis
Active stage:
with polymorhpy nuclear neutrophils
infiltration
Quiescent stage:
without polymorhpy nuclear neutrophils
infiltration

17.

Chronic gastritis
With
Metaplasia: intestinal
Psueodopyloric

18.

Intestinal metaplasia

19.

chronic gastritis with
Dysplasia
mild,
moderate,
severe

20.

Chronic gastritis with dysplasia

21.

Clinical Manifestations
Most of patients are asymptomatic
Dyspepsia: upper abdominal pain or
discomfort (bloating, belching, nausea
vomiting)
The symptoms are not specific
No typical physical sign found

22.

Laboratory and other
examinations
Endoscopy examination with mucosal
biopsy
the most reliable method for diagnosis

23.

Endoscopy examination
superficial gastritis
edema, erythema, exudate,
erosion

24.

Edema
erythema

25.

Atrophic gastritis
grey, reduced mucosa folds,
submucosal visible vessels

26.

Visible
vessels

27.

Note
imperfect co-relations between
endoscopic appearances and
histological classification, the
final diagnosis should be made
by histological examination.

28.

Detection of H. pylori
Urease test
Histology
Microbiological culture
Breath test: 13C-urea
14C-urea
Serology: IgG

29.

Gastric acid secretion and
serology tests
Type A gastritis
serum anti-parietal cell antibody: (+)
serum anti-intrinsic factor antibody: (+)
serum gastrin:
basic and maximal (pengastrin
stimulated) gastric acid secretion :

30.

Type B gastritis
usually in normal range of above
tests
gastrin and gastric acid secretion
decreased when severe atrophy
occurred

31.

Etiology
Topography
BAO & MAO
gastrin
APCA
Associated
disease
Type A
auto immunity
corpus
Type B
H.p.
Environment factors
antrum
+
pernicious anemia
-- or
--peptic ulcer

32.

Treatment
Exclusion of causative factors
smoking, alcohol, NSAIDs, salty food
Medication
relief of pain: antacid, H2-RA, PPI
prokinetic agents: to enhance gastric
motility, promote gastric empty

33.

Anti-microbiotic therapy
There are still some arguments
No a effective, low side-effect and
low price medicine available
Eradication of Hp is not means
improvement of symptoms

34.

How should we do?
Eradication of H.p.
When the patient’s symptom is
intractable
When the patient from the high risk
area of gastric cancer
When the patient wishes to be
treated

35.

Surgery
Only in chronic gastrits with
severe dysplasia , because of
dysplasia is regarded as
precancerous lesion and it is hard to
distinguish severe dysplasia and
early gastric cancer

36.

Prognosis
• Normal mucosa CSG CAG? GC
• There is a risk from atrophic gastritis
(especially with moderate to severe
dysplasia) developing to gastric cancer.

37.

Summary
Chronic gastritis is a common disease
Type A : auto immunity
Type B : H. Pylori infection
Symptom : dyspepsia
Diagnosis : endoscopy with histology
Treatment : symptoms relief
Prognosis